Hawaii on front lines for bird flu

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Here's a cool article that i stumble accross that was featured in the Chicago Tribune.

Hawaii on front lines for bird flu

BY KIRSTEN SCHARNBERG

Chicago Tribune

HONOLULU - The plans, detailed and terrifying, are for the worst-case scenario.

One section of this city's bustling, tourist-filled airport could be converted into an emergency quarantine station for patients suspected of carrying avian influenza. Special air filters would kick on to prevent the deadly virus from spreading. And medical personnel entering the quarantine area would wear special protective suits.

As avian flu continues to spread across the globe, health officials are paying close attention to Hawaii, the nation's gateway to Asia and the state where some experts believe the much-feared H5N1 virus could first be detected on American soil.

In what is being seen as a model for the rest of the United States, Hawaii has become the first state in the country to establish an airport surveillance program to test visibly ill passengers for avian flu, many arriving from nations where the virus already has proved deadly.

Fear of a flu pandemic capable of killing millions has been rising since the H5N1 virus - initially detected in Southeast Asia - began spreading so quickly throughout the world in recent months. The virus, known colloquially as bird flu and blamed for at least 93 deaths worldwide, has yet to show any evidence of spreading through human-to-human contact, but health officials across the United States are preparing for that frightening scenario.

Yet even as states nationwide draft and publicly release pandemic influenza plans, in few places are preparations - and worry - as visible as in Hawaii.

A tourism-driven state with an Asian visitor-to-U.S. resident ratio that surpasses any other place in America, Hawaii has gone much further than just testing visitors for avian flu, so far only on a voluntary basis.

Because the islands sit on a migratory bird path that between April and August will bring to Hawaii several bird species believed to be possible carriers of avian flu, state scientists are launching a push to routinely test birds, domestic and migratory, throughout the state. A new lab capable of testing human mucus samples for the virus - samples that once had to be sent all the way to a government lab in Atlanta - has opened on the island of Oahu in recent months.

And because Hawaii is so isolated from the rest of the United States, its businesses, hospitals and families have begun to prepare for the possibility that the state, which has only about a week's worth of food, might be cut off from supply ships and easy mainland air travel should a flu pandemic grip either Hawaii or other parts of the United States.

"We recognize that we cannot put up a wall to keep the virus out, particularly because of our geographic proximity to the nations that have seen the most human infection of the virus and the fact that so many people travel to and from Hawaii from those areas," said Dr. Sarah Park, deputy chief of the Hawaii Health Department's disease outbreak control division. "But we have determined that we can be prepared for the possibility of the virus making its way here."

SARS, a deadly respiratory illness first seen widely in Asia in 2003, was deeply feared on these islands so heavily visited by people from Japan, China and other Asian nations. And Hawaii has been diligent about monitoring ill passengers who arrive at Honolulu's airport ever since.

As it does in 18 other U.S. cities, the Centers for Disease Control and Prevention has for many years had a quarantine station in the Honolulu airport that is alerted by airline personnel of arriving flights bearing sick passengers. Passengers believed to be ill with or exposed to any of nine quarantine-worthy illnesses - including SARS, smallpox and infectious tuberculosis - can be hospitalized and placed in mandatory isolation for testing.

But Hawaii announced in November that it was going one step further. The state health department assigned a medical team to test sick airline passengers arriving in Honolulu for all forms of influenza, including avian. The state has not said how many people have agreed to this voluntary testing.

A poll released last week by the Harvard School of Public Health showed that 60 percent of Americans are concerned about bird flu. Still, fewer than one-third of Americans believe bird flu will reach American shores this year.

But many Hawaiians appear to be deeply concerned. "We sit on these remote islands in the middle of the Pacific Ocean, and often find ourselves sitting in front of the television watching to see if a projected hurricane is going to stay on a path that sends it disastrously right over us," said Chris Chiesa, who has been mapping the spread of the virus for the Pacific Disaster Center on Maui. "Avian flu is a little like watching for that hurricane, and people here take that pretty seriously."

By virtually everyone's estimation, Hawaii would face unique challenges in the event of a U.S. pandemic.

Hawaii's economy is deeply dependent on tourism, a source of revenue that would disappear almost immediately upon detection of a flu that spreads by human-to-human contact.

How the state would cope with long interruptions in shipping is an unknown. During hurricane scares, for example, grocery stores routinely run out of fresh food and critical supplies. After the Sept. 11 terror attacks, when ships were held at Western U.S. ports, food and medical shipments were delayed for weeks.

Another major fear is that Hawaii hospitals, which routinely have about 90 percent of their beds filled, would be inundated during a pandemic. About $1 million in federal money has been used in recent months to stockpile equipment and hospital supplies.

"If our hospitals get overrun, we don't just have the luxury of sending patients to a neighboring state that may have extra beds or more doctors," said Nancy Davis Lewis, the director of research at the East-West Center in Hawaii and a specialist on the geography of health and disease.

Most experts believe that should the avian virus make it to Hawaii, it would arrive on mechanical wings, not feathered ones, but the threat from birds cannot be ruled out.

"Another great risk is the number of migratory birds that breed in the Arctic and Alaska that make their way to the Hawaiian Islands," said Dr. Duane Gubler, director of the Asia-Pacific Institute of Tropical Medicine at the University of Hawaii. "There are a number that do, and that's concerning."

German authorities announced Tuesday that a cat has become the first mammal known to be infected in the European Union, and that the animal was found on an island where more than 100 infected wild birds have been found.

Gubler said Hawaiians seem to have been watching the H5N1 virus closely. Speaking to a gathering of health professionals at the University of Hawaii's Medical School recently, he said that he has had people show up at his office with dead birds - carefully wrapped in plastic - that they have found.

"They say, `You should test this. It seems suspicious,'" said Gubler, who coordinated the U.S. National Lyme Disease Program and who was previously the director of the division of vector-borne infectious diseases for the CDC.

Still, experts in avian flu urge a measured approach in Hawaii - and elsewhere. Anthony Marfin, the supervisory medical officer with the CDC's division of global migration and quarantine, stresses that avian flu has yet to morph into the kind of virus that can spread between humans, as did the deadly influenza strains that became pandemics that killed millions in 1918, 1957 and 1968.

Even more, Marfin warned that no one should think that Hawaii is the only place at risk.

"The truth is that with our world being so transient today, someone can wake up in Tokyo and be anywhere by that night," he said.

"We can't get lulled into thinking this can only come to us in certain places. Someone may touch down in Honolulu, but very quickly they are going to be on planes to Seattle or Portland or Chicago."